Multi-modality apparatus

ABSTRACT

A harness comprising a patient module connector, an extremity hub; a cable branch including a plurality of channel pairs. The cable branch includes a first end coupled to the patient module connector and a second end coupled to the extremity hub. The harness comprises a monitoring cable configured to attach and detach from the extremity hub.

FIELD

This disclosure describes a harness and a monitoring cable for useduring a surgical procedure.

BACKGROUND

Electromyography (EMG) is the study of the electrical activity ofmuscles. It is a test used to help assess the health and function ofnerves and/or muscles. EMG can be used by a surgeon to assess properpedicle screw placement in fusion surgeries to help reduce the chance ofnerve damage, or to aid in assessing nerve proximity and location duringsurgical approaches. Typically, one or more hardware and softwarecomponents are used to assist in performing an EMG test during asurgical procedure.

SUMMARY

In one embodiment, a harness comprises a patient module connector, anextremity hub, a cable branch including a plurality of channel pairs.The cable branch includes a first end coupled to the patient moduleconnector and a second end coupled to the extremity hub. The harnesscomprises a monitoring cable configured to attach and detach from theextremity hub. The monitoring cable includes a first electrode wire, asecond electrode wire, and a housing. The housing is configured toreceive a first end of the first electrode wire and a first end of thesecond electrode wire. The housing includes a first aperture and asecond aperture along an axis of the housing. The monitoring cableincludes a body that includes a channel formed by an aperture along afirst axis of the body. The channel includes a first retention elementlocated on a first surface of the channel and along a second axis of thebody. The channel includes a second retention element located along asecond surface of the channel and along the second axis. The first axisand the second axis are perpendicular. The body is configured toslidably receive the housing. The housing is held in a fixed positionbased on insertion of the first retention element within the firstaperture and insertion of the second retention element within the secondaperture.

In another embodiment, a monitoring cable comprises a first electrodewire, a second electrode wire, and a housing. The housing is configuredto receive a first end of the first electrode wire and a first end ofthe second electrode wire. The housing includes a first aperture and asecond aperture along an axis of the housing. The monitoring cablecomprises a body. The body includes a channel formed by an aperturealong a first axis of the body. The channel includes a first retentionelement located on a first surface of the channel and along a secondaxis of the body. The aperture includes a second retention elementlocated along a second surface of the channel and along the second axis.The first axis and the second axis are perpendicular. The body isconfigured to slidably receive the housing. The housing is held in afixed position based on insertion of the first retention element withinthe first aperture and insertion of the second retention element withinthe second aperture.

In another embodiment, a harness comprises a patient module connector,an extremity hub, and a cable branch including a plurality of channelpairs. The cable branch includes a first end coupled to the patientmodule connector and a second end coupled to the extremity hub. Theharness includes a monitoring cable. The monitoring cable is configuredto attach and detach from the extremity hub. The monitoring cableincludes a plurality of electrode wires and a plurality of housingsconfigured to receive the plurality of electrode wires. The plurality ofhousings includes a plurality of apertures. The monitoring cableincludes a body. The body includes a plurality of channels formed by aplurality of apertures along the body. The plurality of channels includea plurality of retention elements located on surfaces of the pluralityof channels. The body is configured to slidably receive the plurality ofhousings and hold the plurality of housings in fixed positions based oninsertion of the plurality of retention elements within the plurality ofapertures.

BRIEF DESCRIPTION OF THE DRAWINGS

Many advantages of the present invention will be apparent to thoseskilled in the art with a reading of this specification in conjunctionwith the attached drawings, wherein like reference numerals are appliedto like elements and wherein:

FIG. 1 illustrates an example harness for performing a surgicalprocedure, according to an embodiment of the present disclosure;

FIG. 2 illustrates an example extremity hub of FIG. 1 for performing asurgical procedure, according to an embodiment of the presentdisclosure;

FIG. 3 illustrates another example extremity hub of FIG. 1 forperforming a surgical procedure, according to an embodiment of thepresent disclosure;

FIG. 4 illustrates an example housing for performing a surgicalprocedure, according to an embodiment of the present disclosure;

FIG. 5 illustrates a cross-sectional view of the example housing of FIG.4 coupled to the example extremity hub of FIG. 2 for performing asurgical procedure, according to an embodiment of the presentdisclosure;

FIG. 6 illustrates an example body for performing a surgical procedure,according to an embodiment of the present disclosure;

FIG. 7 illustrates the example housing of FIG. 4 coupled to the examplebody of FIG. 6 for performing a surgical procedure, according to anembodiment of the present disclosure;

FIG. 8 illustrates an example monitoring cable for performing a surgicalprocedure, according to an embodiment of the present disclosure;

FIG. 9 illustrates the example monitoring cable of FIG. 8 for performinga surgical procedure, according to an embodiment of the presentdisclosure;

FIG. 10 illustrates an example monitoring cable for performing asurgical procedure, according to an embodiment of the presentdisclosure;

FIG. 11 illustrates the example harness of FIG. 1 and example monitoringcables for performing a surgical procedure, according to an embodimentof the present disclosure.

DETAILED DESCRIPTION

Illustrative embodiments of the invention are described below. In theinterest of clarity, not all features of an actual implementation aredescribed in this specification. It will of course be appreciated thatin the development of any such actual embodiment, numerousimplementation-specific decisions must be made to active the developers'specific goals, such as compliance with system-related andbusiness-related constraints, which will vary from one implementation toanother. Moreover, it will be appreciated that such a development effortmight be complex and time-consuming, but nevertheless be a routineundertaking for those of ordinary skill in the art having the benefit ofthis disclosure. It is furthermore to be readily understood that,although discussed below primarily within the context of spinal surgery,the systems and methods of the present invention may be employed in anynumber of anatomical settings to provide access to any number ofdifferent surgical target sites throughout the body.

Examples described herein include a harness and a monitoring cable forperforming a surgical procedure. In one example, a harness for useduring a surgical procedure includes a patient module connector. Thepatient module connector is configured to connect to a monitoring systemfor providing various neurophysiologic assessments during the surgicalprocedure. The harness also includes an extremity hub. The extremity hubincludes one or more connectors for mating with one or more wiresconnected to one or more electrodes. The harness also includes a cablebranch including a plurality of channel pairs. The plurality of channelpairs are configured for providing one or more stimulation signals tovarious locations of a body of a patient during the surgical procedure.The plurality of channel pairs are also configured for acquiring one ormore responses based on the one or more stimulation signals. In oneexample, the responses are provided to the monitoring system foranalysis and for providing feedback to a user during the surgicalprocedure. In one example, the cable branch includes a first end coupledto the patient module connector and a second end coupled to theextremity hub. In another example, the harness includes multiple cablebranches that are also coupled to the patient module connector and theextremity hub as described herein.

The harness also includes a monitoring cable configured to attach anddetach from the extremity hub. In one example, the monitoring cableincludes at least a first electrode wire and a second electrode wire.The monitoring cable also includes a housing that is integrally moldedto receive a first end of the first electrode wire and a first end ofthe second electrode wire. In one embodiment, the housing includes afirst aperture and a second aperture along an axis of the housing. Inanother embodiment, the housing includes additional apertures along oneor more axes of the housing. The monitoring cable also includes a bodythat includes an aperture along a first axis of the body. The apertureincludes a first retention element located on a first surface of theaperture and along a second axis of the body. The aperture also includesa second retention element along a second surface of the aperture andalong the second axis. In one embodiment, the first axis and the secondaxis are perpendicular. The body of the monitoring cable is configuredto slidably receive the housing. The body is held in a fixed positionbased on insertion of the first retention element within the firstaperture and insertion of the second retention element within the secondaperture.

Referring now to the figures, FIG. 1 is a diagram of an example harness100 for performing a surgical procedure. The example harness 100includes a patient module connector 102, cable branches 104, 106, 108,110, and 112, and extremity hubs 114, 116, 118, 120, and 122.

The patient module connector 102 includes a connection point to apatient module (not shown). In one example, the patient module connector102 includes 70 distinct channels. Continuing with this example, thepatient module connector 102 includes a programmable memory device. Inone example, the programmable memory device is an electrically erasableprogrammable read-only memory. In one example, there are numerousstimulation channels for providing a stimulation signal to the body of apatient during a surgical procedure and numerous acquisition channelsfor acquiring a response to a stimulation signal provided to the body ofthe patient.

The cable branches 104, 106, 108, 110, and 112 are designed to utilizethe same cable construction. In one example, the cable branch 104includes six acquisition channel pairs and one stimulation channel pair.Continuing with this example, the insulation surrounding the stimulationchannel pair needs to ensure 1500 VAC isolation between the six channelacquisition channel pairs. In one example, cable branches 106, 110, and112 are configured in a similar manner as described above with regard tocable branch 104. In this example, cable branch 108 has an invertedlayout that includes one acquisition channel pair, five stimulationchannel pairs, and one channel pair for ground.

The extremity hubs 114, 116, 118, 120, and 122 are designed to utilizethe same overmold design. The same overmold design enables the extremityhubs to use the same tool. This also optimizes manufacturing costs aswell as ensuring a reproducible design. In one example, the extremityhubs 114, 116, 120, and 122 have the same connector layout.

FIG. 2 illustrates a front view of the extremity hub 114 of FIG. 1 . Asshown in FIG. 2 , the extremity hub 114 includes seven pairs of dualconnector female receptacles 202, 204, 206, 208, 210, 212, and 214.There are four dual connector female receptacles 202, 204, 206, and 208in a vertical orientation along a first axis of the extremity hub 114and three dual connector female receptacles 210, 212, and 214 in ahorizontal orientation along a second axis of the extremity hub 114. Asshown in FIG. 2 , the dual connector female receptacle 202 includesretention elements 216, 218, 220, and 222. The dual connector femalereceptacle 204 includes retention elements 224, 226, 228, and 230. Thedual connector female receptacle 206 includes retention elements 232,234, 236, and 238. The dual connector female receptacle 208 includesretention elements 240, 242, 244, and 246. The dual connector femalereceptacle 210 includes retention elements 248, 250, 252, and 254. Thedual connector female receptacle 212 includes retention elements 256,258, 260, and 262. The dual connector female receptacle 214 includesretention elements 264, 266, 268, and 270. In one example, the extremityhubs 116, 120, and 122 the same connector layout to the connector layoutof extremity hub 114. In one example, the extremity hub 118 has asimilar connector layout to the connector layouts of extremity hubs 114,116, 120, and 122 except for two of the dual female connectorreceptacles along the second axis.

FIG. 3 illustrates a front view of the extremity hub 118 of FIG. 1 . Asshown in FIG. 3 , the extremity hub 118 includes five pairs of dualconnector female receptacles 302, 304, 306, 308, and 310. In place ofthe other two dual female connector receptacles of the extremity hub114, the extremity hub 118 includes a pair of Deutsches Institut furNormung (DIN) connections points 312 and 314. In one example, the DINconnection points provide connection points for motor evoked potential(MEP) cranial stimulation leads. In another example, the DIN connectionpoints provide connection points for transabdominal stimulation andgeneration of transabdominal muscle action potentials.

FIG. 4 illustrates an example housing 402 that includes an electrode.The housing 402 includes apertures 404, 406, 408, and 410. The housing402 also is integrally formed with electrode wires 412 and 414. Thehousing 402 includes apertures 404 and 406 along an axis 416 andapertures 410 and 408 along an axis 418. As shown in FIG. 4 , the axis416 is parallel to axis 418. However, it is envisioned that theapertures 404, 406, 408, and 410 may be positioned in variousconfigurations along the surface of housing 402. By way of example, oneor more apertures may be included or removed from the apertures as shownin FIG. 4 .

The housing 402 may be attached to or detached to one of the extremityhubs 114, 116, 118, 120, and 122 of FIG. 1 . In one example, the housing402 is attached to a dual connector female receptacle of one of theextremity hubs 114, 116, 118, 120, and 122. By way of example, when thehousing 402 is attached to the extremity hub 114, the apertures 406 and408 are configured to receive the retention elements 216 and 220 of dualconnector female receptacle 202 of extremity hub 114 of FIG. 2 .Continuing with this example, the apertures 404 and 410 are configuredto receive to receive the retention elements 218 and 222 of dualconnector female receptacle 202. For example, FIG. 5 illustrates across-sectional view of the housing 402 attached to the extremity hub114 of FIG. 2 . The retention elements 216, 218, 220, and 220 of thedual connector female receptacle 202 ensure that an electricalconnection is maintained between the electrode of the housing 402 andthe extremity hub 114.

FIG. 6 illustrates an example body 626 configured to receive one to fourhousings (e.g., housing 402). The body 626 includes an aperture 632located along an axis 640 of the body 626, an aperture 634 located alongan axis 642 of the body 626, an aperture 636 located along an axis 644of the body 626, and an aperture 638 located along an axis 646 of thebody 626. Each of the apertures 632, 634, 636, and 638 formcorresponding channels 633, 635, 637, and 639 within the body 626. Thebody 626 includes a first tab 628 coupled to a first surface of the body626 and a second tab 630 coupled to a second surface of the body 326. Asshown in FIG. 6 , the first surface is opposite of the second surface.In one example, the first tab 628 and the second tab 630 are configuredto attach and detach from an extremity hub (e.g., extremity hubs 114,116, 118, 120, and 122). For example, FIG. 7 illustrates across-sectional view of the housing 402 attached to the body 626. Asshown in FIG. 7 , the body 626 is attached to the extremity hub 114 ofFIG. 2 at a first location 728 via the first tab 628 and a secondlocation 730 via the second tab 630.

Referring back to FIG. 6 , the channel 633 formed by the aperture 332includes retention elements 652 and 654 along a first surface of thechannel 633 and retention elements 656 and 658 along a second surface ofthe channel 633. In one example, the retention elements 652, 654, 656,and 658 are similar to the retention elements (e.g., 216, 218, 220, and222) of the dual female connector receptacles of the extremity hubs(e.g., extremity hub 114 of FIG. 2 , extremity hub 118 of FIG. 3 ). Asshown in FIG. 6 , the retention elements 652 and 656 are located alongan axis 648. The retention elements 654 and 658 are located along anaxis 650. The axis 640 is perpendicular to the axes 648 and 650.

The channel 635 formed by the aperture 634 includes retention elements660 and 662 along a first surface of the channel 635 and retentionelements 664 and 666 along a second surface of the channel 635.Retention elements 660 and 664 are located along the axis 648. Retentionelements 662 and 666 are located along the axis 650. The axis 642 isparallel to axis 640 and perpendicular to the axes 648 and 650.

The channel 637 formed by the aperture 636 includes retention elements668 and 670 along a first surface of the channel 637 and retentionelements 672 and 674 along a second surface of the channel 637.Retention elements 668 and 672 are located along the axis 648. Retentionelements 670 and 674 are located along the axis 650. The axis 644 isparallel to axis 642 and perpendicular to the axes 648 and 650.

The channel 639 formed by the aperture 638 includes retention elements676 and 678 along a first surface of the channel 639 and retentionelements 680 and 682 along a second surface of the channel 639.Retention elements 676 and 680 are located along the axis 648. Retentionelements 678 and 682 are located along the axis 650. The axis 646 isparallel to axis 644 and perpendicular to the axes 648 and 650.

FIG. 8 illustrates an example monitoring cable 800 that may be attachedto or detached from an extremity hub (e.g., extremity hubs 114, 116,118, 120, and 122). The monitoring cable 800 includes electrode wires802, 804, 806, 808, 810, 812, 814, and 816, housings 818, 820, 822, and824, and body 826. In one example, the housings 818, 820, 822, and 824are configured as the housing 402 of FIG. 4 . In one example, the body826 is configured as the body 626 of FIG. 6 .

Prior to commencing a surgical procedure, the electrode wires 802, 804,806, 808, 810, 812, 814, and 816 are configured to monitor various partsof a patient's body. In one example, in surgical procedure that involvesa portion of the cervical spine, the electrodes associated withelectrode wires 802 and 804 may be placed at the trapezius, theelectrodes associated with electrode wires 806 and 808 may be placed atthe triceps, the electrodes associated with electrode wires 810 and 812may be placed at the abductor pollicis brevis and the abductor digitiminimi, and the electrodes associated with electrode wires 814 and 816at the deltoid. In another example, in a surgical procedure thatinvolves a portion of the lumbar spine, the electrodes associated withelectrode wires 802 and 804 may be placed at the vastus medialis, theelectrodes associated with electrode wires 806 and 808 may be placed atthe biceps femoris, the electrodes associated with electrode wires 810and 812 may be placed at the gastroc medial, and the electrodesassociated with electrode wires 814 and 816 at the tibialis anterior.

Housings 818, 820, 822, and 824 are configured to receive a first end ofa first electrode wire and a first end of a second electrode wire. Thehousings 818, 820, 822, and 824 are also configured to attach to anddetach from the body 826. For example, as shown in FIG. 9 , housing 818has been detached from the body 826 while housings 820, 822, and 824 areshown attached to the body 826. The ability to remove a single housingfrom the body 826 while allowing the other housings to remain connectedto the body 826 helps to reduce the time necessary to prepare a patientfor a surgical procedure. In one scenario, a user may receive an alertvia monitoring system (not shown) coupled to the harness 100 thatindicates a problem with the electrodes associated with electrode wires802 and 804 corresponding to housing 818. In this scenario, the user maychoose to remove only housing 818 and replace it with another housingwithout having to take the time to replace all the other electrodes andcorresponding housings.

Referring back to FIG. 8 , the body 826 includes a first tab 828 coupledto a first surface of the body 826 and a second tab 830 coupled to asecond surface of the body 826. As shown in FIG. 8 , the first surfaceis opposite of the second surface. In one example, the first tab 828 andthe second tab 830 are configured to attach and detach from an extremityhub (e.g., extremity hubs 114, 116, 118, 120, and 122).

FIG. 10 illustrates a top view of a monitoring cable 1000. In oneexample, the monitoring cable 1000 is similar to the monitoring cable800 of FIG. 8 . As shown in FIG. 10 , the body 826 is configured toslidably receive housings 818, 820, 822, and 824. The housings 818, 820,8322, and 824 are held in a fixed position based on insertion of theretention elements 852, 856, 860, 864, 868, 872, 876, and 880 withinapertures (e.g., apertures 402, 406, 408, and 410 of housing 402 of FIG.4 ) of housings 818, 820, 822, and 824.

FIG. 11 illustrates the harness 100 of FIG. 1 coupled to monitoringcables 1104, 1108, 1110, and 1112 and not coupled to monitoring cable1106. In one example, the monitoring cables 1104, 1106, 1108, 1110, and1112 are similar to the monitoring cable 800 of FIG. 8 and themonitoring cable 1000 of FIG. 10 . As shown in FIG. 11 , the monitoringcables 1104, 1106, 1108, 1110, and 1112 are configured to attach anddetach from the extremity hubs 114, 116, 118, 120, and 122 in a manneras described above.

It should be understood that arrangements described herein are forpurposes of example only. As such, those skilled in the art willappreciate that other arrangements and other elements (e.g. machines,interfaces, functions, orders, and groupings of functions, etc.) can beused instead, and some elements may be omitted altogether according tothe desired results. Further, many of the elements that are describedare functional entities that may be implemented as discrete ordistributed components or in conjunction with other components, in anysuitable combination and location, or other structural elementsdescribed as independent structures may be combined.

1-2. (canceled) 4-20. (canceled)
 21. An apparatus comprising: a patientmodule connector; an extremity hub; a cable branch including a pluralityof channel pairs, wherein the cable branch includes a first end coupledto the patient module connector and a second end coupled to theextremity hub; and a monitoring cable configured to attach and detachfrom the extremity hub, wherein the monitoring cable includes: aplurality of housings that each include a plurality of electrode wires,wherein each housing of the plurality of housings includes at least oneaperture; and a body that includes a plurality of channels, wherein theplurality of channels include a plurality of retention elements locatedon surfaces of the plurality of channels, wherein the body is configuredto slidably receive one or more of the plurality of housings and fixedlyhold the one or more of the plurality of housings using correspondingretention elements of the plurality of channels and one or moreapertures of the one or more of the plurality of housings.
 22. Theapparatus of claim 21, further comprising: a first tab coupled to afirst surface of the body; and a second tab coupled to a second surfaceof the body, wherein the first surface is opposite of the secondsurface, wherein the first tab and the second tab are configured toattach and detach from the extremity hub.
 23. The apparatus of claim 22,wherein the first tab is configured to attach to the extremity hub at afirst location and the second tab is configured to attach to theextremity hub at a second location.
 24. The apparatus of claim 21,wherein the patient module connector comprises a programmable memorydevice.
 25. The apparatus of claim 21, wherein at least one of theplurality of channel pairs are configured to provide a stimulationsignal to one or more locations of a body of a patient.
 26. Theapparatus of claim 25, wherein at least one of the plurality of channelpairs are configured to acquire one or more responses based on thestimulation signal.
 27. The apparatus of claim 21, wherein the pluralityof channel pairs are configured to provide one or more stimulationsignals and acquire one or more responses to the one or more stimulationsignals applied to a patient.
 28. The apparatus of claim 21, furtherconfigured to maintain an electrical connection between at least oneelectrode and the extremity hub.
 29. The apparatus of claim 21, whereinthe body is configured to receive at least four housings.
 30. Theapparatus of claim 21, wherein the body is configured with a pluralityof apertures dimensioned to receive the plurality of housings.
 31. Theapparatus of claim 21, further comprising one or more additionalextremity hubs having a same connector layout or a different connectorlayout.
 32. A monitoring cable configured to be coupled to an extremityhub of a cable branch, the monitoring cable comprising: a plurality ofhousings that each include a plurality of electrode wires, wherein theplurality of housings include a plurality of apertures; and a body thatincludes a plurality of channels, wherein the plurality of channelsinclude a plurality of retention elements located on surfaces of theplurality of channels, wherein the body is configured to slidablyreceive one or more of the plurality of housings and fixedly hold theone or more of the plurality of housings using corresponding retentionelements of the plurality of channels and apertures of the one or moreof the plurality of housings.
 33. The monitoring cable of claim 32,further comprising: a first tab coupled to a first surface of the body;and a second tab coupled to a second surface of the body, wherein thefirst surface is opposite of the second surface, wherein the first taband the second tab are configured to attach and detach from theextremity hub.
 34. The monitoring cable of claim 32, wherein eachchannel of the body includes a first retention element on a firstsurface and a second retention element on a second surface.
 35. Themonitoring cable of claim 34, wherein each channel of the body includesa third retention element on the first surface of the channel and afourth retention element on the second surface of the channel.
 36. Themonitoring cable of claim 35, wherein each housing includes a firstaperture and a second aperture along a first axis of each housing and athird aperture and a fourth aperture along a second axis of eachhousing, wherein the second axis is parallel to the first axis, whereineach housing is held in a fixed position based on insertion of the firstretention element within the first aperture, the second retentionelement within the second aperture, the third retention element withinthe third aperture, and the fourth retention element within the fourthaperture.
 37. The monitoring cable of claim 32, wherein the plurality ofchannels of the body include four channels formed by four apertures,wherein each channel includes opposing retention elements for connectingto corresponding housing apertures.
 38. A apparatus comprising: apatient module connector; a plurality of extremity hubs; a plurality ofcable branches, wherein each cable branch includes a first end coupledto the patient module connector and a second end coupled to one of theplurality of extremity hubs; and at least one monitoring cableconfigured to attach and detach from one of the plurality of extremityhubs, wherein the monitoring cable includes: at least one housing thatincludes a plurality of electrode wires and a plurality of apertures;and a body that includes a plurality of channels, wherein the pluralityof channels include a plurality of retention elements located onsurfaces of the plurality of channels, wherein the body is configured toslidably receive the at least one housing and fixedly hold the at leastone housing using corresponding retention elements of one of theplurality of channels and the plurality apertures of the at least onehousing.
 39. The apparatus of claim 38, wherein each of the plurality ofchannels include a pair of opposing retention elements located onopposing surfaces.
 40. The apparatus of claim 38, further comprising: afirst tab coupled to a first outer surface of the body; and a second tabcoupled to a second outer surface of the body, wherein the first tab andthe second tab are configured to attach and detach from an extremityhub.